3yr old, chronic constipation. Toilet trained for passing urine but difficult with getting her to poo in the toilet

[Annoymous111]

Hi, i am in need of any advice at all. My daughter has suffered with constipation from being a newborn. She been on movicol from birth and is still now on 1-2 sachets a day. She toilet trained for wee's will verbalise she needs a wee and will run to the toilet, no accidents at all. But Poo's is a huge issue. She will just go in her knickers- Sometimes will carry on playing once she's done it, other times will go and try and clean herself up. When i ask her what's happened she's replies i've had a poo and when i say where should that have gone she says the toilet, so she knows. I don't know whether she engrossed in play, whether she doesn't realise the sensation till its too late or not.
She attends a school Nursery which they need to be fully toilet trained and this is now becoming an issue. I really don't know what else to do. She's on 1 sachet a day which we use to give in the morning but changed to after school to try and avoid any accidents - but this is not working and occurring every single day now. I put her on the toilet in the morning, when she's home from school and before bed and she doesn't go. The school has asked me to stop or cut down her movicol which i ve said i carn't. I asked whether they have a school nurse who i can liaise with but they are none existent apparently.
About 4 weeks ago she got that constipated i could see it and it Obviously was hurting her and she pulled it back up so had to increase the does and don't want her getting to that stage again. I ve been in contact with HV but doing the things they suggested, shes getting me in touch with the community nurses and waiting their call which could be weeks ive been told. Could just do with any advice, tips and tricks if anyone else has experienced i honestly will be very very grateful.

Go to GP and ask for a continence referral if they have one in your area. This can take a while so...I will share my knowledge!

The poo is basically just sitting down low and building up. She won't be able to feel this really or have the 'urge' to go because she's backed up.

What happens is wetter poop sat behind the blockage seeps it's way past and causes smears, nuggets etc which she won't be able to feel. Over time it's possible for the colon to stretch (mega colon) so much that it can take months even years to recover and shrink back to its normal size by regular laxatives. Don't stop or reduce the movicol, it's not going to do her any harm.

If I was you I would increase the movicol, as oddly enough, not enough movicol can increase the accidents (which isn't what you'd think!)...she needs enough movicol for the whole mass of poop to come out at once...not wet bits sliding past dry harder bits. I would give her 4-6 sachets on a Friday and await a 'clear out: situation and then go for a regular higher dose such as 3 sachets a day. Change dosage accordingly but 100% do not be deterred by nursery. More dosage will

a) clear her out properly
b) help stop the smearing/nuggets
c) help her sense when she needs to go
d) help shrink a stretched colon
e) reduce her fear of pain and break a with-holding habit.

This...and regular 'sits' for a poop half an hour after eating a meal. Get her a stool, check out sitting postures etc online, get her relaxed with a tablet or something.

Check out the poop charts...she wants to be doing a type 4-5 poop.

Be confident with the movicol...don't reduce it. It's better to clear her out than have a partial situation where she's essentially still backed up even though she seemingly has runny poops.

Good luck :)

The charity ERIC is really helpful.

Thank you for taking the time to reply. This is very helpful thank you.

You're welcome...it's really traumatising and difficult to deal with.

You can also try a 'sweetcorn test' to see how long stuff takes to go through. A bowl of sweetcorn (if she'll eat it ofc!) with butter etc and then see how long it takes before you no longer see it in her poop. A healthy system is meant to be 1-2 days. Anyhow that doesn't exactly fix the problem.

It can feel like you're giving them too much movicol because the poops are loose but in reality there's constipation still in there. It's just a case of not being too afraid to go for a higher dose or even a weekly big dose to clear out. She may need more when ill, eg a cold, hot summer days etc.

She'll probably still have accidents (and bigger ones) initially, or not get it the loo on time for a while, but don't let this deter you, she will soon start to learn the feeling to go.

They develop a fear of going because it hurts and then a habit of withholding which just makes it worse over time. It will be good if she can begin to associate pooping with it not hurting.

Yes second this whilst you're waiting to get specific help.

Google ERIC for the website

The sweetcorn test - that's such a good idea, thank you so much. Honestly i really appreciate the comments and advice :) x

Just to say I am having a similar issue with my 3 yo daughter so you're not alone.

My dd is brilliant at toilet for wees but more often than not poos in her knickers. At home, I keep her knickers off and she will poo in the potty. If she has knickers on, we literally have to rush her to the potty when we see signs - crossing her legs. At nursery, it's just always in her knickers. We're doing sticker charts and she gets a present after 10 poos on the potty for positive reinforcement.

Our daughter is also on movicol and was very badly constipated a year ago and got into the cycle of withholding so I think that has delayed her toilet training and she just hates pooing.

So no real advice, but you're doing a great job and it's very common

Thank you for taking the time to reply. Honestly this is amazing knowing I'm not alone and others have been or going through the same issues.

My son was like this. Eric is great, we found in his case that he’d developed a milk protein allergy - as well as constipation he suffers from anemia, hives and eczema. We removed dairy from his diet (with dietician advice) and introduced prebiotics. He no longer needs movicol at all and we are slowly reintroducing dairy. Prebiotics are such a great tool when dealing with digestion issues - all of his allergies are now very minimal, no eczema at all and very slight hay fever in summer.

School cannot ask her to stop medical treatment! My boy is movicol and was like your child at first, we ended up moving him to two sachets a day because he was still constipated. Don’t withdraw it. Maybe talk to dr about upping dose. My ds GP is a former bowel surgeon and he says micro changes for reducing doses and allow four weeks between. However he is happy with my ds on two a day. We get a reliable bowel movement every evening. It took about 3 months of two a day to get to this.

Sorry you’re going through this OP, it really is underestimated in how distressing it is

I had the same with my DD and unfortunately I don’t have any advice as one day she was just ok. But I’ll never forget the tears (from both of us) and the pure heartbreak of seeing her suffer. Luckily her nursery were great about it, I think yours are awful to suggest stopping medication

I hope you get it sorted ❤️

www.cntw.nhs.uk/wp-content/uploads/2016/08/Poo-Goes-To-Pooland.pdf

Thank you every one for your time in replying. All incredibly helpful. Thank you.

Thanks for posting this @Annoymous111 and thank you for the great advice @Kaleidoscopic101 . I’m in a very similar position with my DC. Reassuring that I’m not alone!

You're absolutely not alone OP.

My DD has been on movicol since she started solids and still is 6 years later.

She potty trained early but took until she was 5 to poo on the toilet (she hated the potty). The only thing that helped was time unfortunately. She had been so constipated that she associated needing a poo with pain and would only go in a pull up while standing. Gradually she would sit on the toilet with the pull up on then slowly we worked on trying without it. Blowing bubbles or trying to blow my hand away helped with the muscles needed to push. She'll still do this now if she's struggling. I know that's a bit different to your situation but maybe could help.

Now she's fine and will take herself off to the loo when she needs to but it seemed like this would never happen when we were in the trenches. She's still only an every other day kind of girl but that's fine.

Definitely don't stop the meds and as PP have said, try an extra couple of sachets to try and clear the backlog. I let DD take her tablet to the toilet to keep her sitting longer or maybe something to play with so she didn't jump off too quickly.

There's a FB group called movicol mummies which was somewhat helpful. I came off it because every child seemed to be advised to fully disimpact with 12 sachets a day until they were totally liquid and I didn't find that necessary for us.

I forgot to mention that the other important thing is to keep liquids up. We were advised 5 x 250ml per day ... I'm sure it's something you do already but this was the advice we were given.

This book was also recommended to be by a Continence Nurse. However I have to be honest that I never read it mainly because the last thing I felt like doing in my precious almost non existent leisure time after relentlessly rinsing out soiled clothes and laundry. But for what it's worth...

Stool withholding - Sophia J Ferguson

You're not alone...no one talks about it. It's super common for this age but also for any aged child. It can also have an impact on wetting. If you have wetting issues, health professionals will always look at bowels and pooping first because the bowel sits so close to the bladder it can restrict it from working properly.

There's really good advise here, thanks. Particularly the sweetcorn test.

Hi OP, you've had lots of great advice on this thread already. I've been through this with both of my DC😩but you can get through it. Here's a bit of a brain dump:

If you DD has been constipated for a while she most likely can't feel when she needs to go as the nerves get affected.

Keep bothering the health visitor and GP (although GPs aren't always great with child constipation) to get a continence team appt.

It's a medical condition, nursery need to wind their necks in and make reasonable adjustments.

If you think you need to lower the movicol dose, chances are you actually need to raise it.

Movicol mummies on FB are good for solidarity but some of the advice is a bit crazy, where people have their DC on 12 sachets of movicol for months at a time. I did have to disimpact DC1 but it only took 10 days and we only had to go up to 8 sachets. DC2 we managed to catch the constipation/withholding before we got to the imapacted stage, so its not always a given that they are impacted.

For us, Senna as well has movicol has been a game changer, but it's not licensed for under 12s so GPs may not want to prescribe without input from continence team.

Glycerin suppositories can be bought over the counter and can be useful as a sort term fix to get things out, as long as you are keeping up the movicol (poo must be soft). My DC will poo about 20 minutes after one.

My dd has suffered constipation since a baby and was prescribed laxido .

Toilet training is often a different process for a severely constipated child .

She wore a pull up for a poo , as it was quite time consuming for her. I'd rather she emptied her bowels than held it in . We didn't need any extra battles. When she was 4, she started pooing on the toilet.

She never needed a poo during school time .

Have a look at poo and the loo on Instagram, she is a paediatric incontinence nurse. She explains it so well.

Hi OP you have been given excellent advice we are going through this problem with a relative. We could have written your account word for word.
Also the child in our family has now been diagnosed with Coeliac disease which we think contributed to the problem.
Now its just getting through the psychological effect of long term constipation, fear of pooing etc
It is very slow progress and we have had help from a paediatric psychologist.
Definitely do not rule out pull ups if your child feels safer and then progress to pull ups only in the bathroom and then just get closer to pooing by the loo.All poo in pants or pull ups gets thrown in the loo and off to pooland!Get your daughter involved in the flushing bit and wave it off .
You have my 100% sympathy , it is a really tricky situation which will take time.
Ask about Coeliac test .
Absolutely second that Movicol needs increasing rather than decreasing butnnot12sachets a day!

Good luck..sending solidarity. X

Overwhelmed with all the responses and advice, so thank you all.

This is such a helpful thread. Same issue with my 3y1m, on movicol for months and every time we get to the stage he will poo regularly (in a nappy), something happens and we go back to holding for several days. Currently 7 days and counting hence me finding this thread! Our new problem is getting the movicol into him - it worked in juice for a while but he’s started refusing that since being ill, I’m always amazed that people get their kids to drink 4-8 sachets, we have never managed more than 2, and currently barely a half. Did you see any improvement OP?